Anxiety Therapy 101: A Guide to Understanding Your Options

Anxiety is a natural response to stress, and is a common experience for many people. However, when anxiety becomes excessive, persistent, and interferes with daily life, it can be diagnosed as an anxiety disorder.

Mood and anxiety disorders are among the most common types of mental disorders in Canada, affecting anywhere from 17% to 25% of the population. While anxiety can be debilitating, there are many effective treatments and therapies available to help individuals manage their symptoms.

This article will explore the different treatments and therapies available to treat anxiety disorders, including psychotherapy, medications, complementary and alternative treatments, new and emerging treatments, and self-help strategies.

Impact of Anxiety

Anxiety can significantly impact an individual’s quality of life, affecting their relationships, work, and overall well-being. Without treatment, anxiety disorders can worsen over time, leading to more severe symptoms and potentially co-occurring disorders, such as depression or substance use disorders.

Anxiety disorders differ considerably, so therapy should be tailored to your specific symptoms and diagnosis. It can be conducted in an individual, family, couple, or group setting, virtually or in person. How often you meet with your therapist and how long will depend on your specific symptoms and diagnosis. Mental health professionals use several types of anxiety therapy, depending on your diagnosis and the severity of your symptoms.

Not seeking treatment for anxiety can lead to negative consequences, such as increased risk for heart disease, insomnia, digestive issues and other health problems. Therefore, it is crucial to seek help if you are experiencing symptoms of an anxiety disorder.

Psychotherapy for Anxiety

Psychotherapy, or talk therapy, is a common treatment for anxiety disorders. There are numerous types of psychotherapy available, including:

• Cognitive-Behavioural Therapy (CBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Acceptance and Commitment Therapy (ACT)
• Dialectical Behavioural Therapy (DBT)
• Exposure Therapy and Virtual Reality Exposure (VRE)
• Interpersonal Therapy (IPT)

Cognitive Behavioural Therapy

CBT is the gold-standard for anxiety treatment because it has the most evidence to support that it works to reduce symptoms in people with generalized anxiety disorder (GAD), panic disorder, specific phobias, and social anxiety disorder. Additionally, it can quickly help patients identify and cope with specific challenges as it generally requires fewer sessions than other types of therapy and is delivered in a structured way.

CBT is a type of talk therapy generally delivered over 12 to 16 weeks, either virtually or in person. It focuses on changing negative thought patterns and behaviours associated with anxiety and developing coping strategies to manage.

Eye Movement Desensitization and Reprocessing

EMDR therapy (Eye Movement Desensitization and Reprocessing) asks the patient to focus briefly on the trauma memory. The patient then simultaneously focuses on an external stimulus such as watching a bright light moving from one side to another for a short period of time.

Unlike other treatments that focus on directly altering the emotions, thoughts and responses resulting from traumatic experiences, EMDR therapy focuses directly on the memory, and is intended to change the way that the memory is stored in the brain. The theory is that this process reduces and ultimately eliminates the vividness and emotion associated with the traumatic memories.

Acceptance and Commitment Therapy

ACT (Acceptance and Commitment Therapy) is a type of therapy that integrates the core tenets of mindfulness into psychotherapy. ACT focuses on accepting difficult thoughts and feelings while accepting that these deeper feelings are appropriate responses to certain situations that should not prevent them from living their lives. It helps individuals develop psychological flexibility, which can reduce the impact of anxiety on their lives.

Dialectical Behavioural Therapy

DBT (Dialectical Behavioural Therapy) is based on cognitive behaviour therapy (CBT) but has been specially adapted to treat individuals who suffer from extremely intense emotions. DBT is used to help struggling individuals identify and positively change negative thinking patterns. Dialectical behavioural therapy teaches four skills that need to work in conjunction with each other. These four skills are mindfulness, interpersonal effectiveness, distress tolerance and emotion regulation.

Exposure Therapy and Virtual Reality Exposure Therapy

Exposure Therapy is a form of therapy designed to help those who are fearful to the extent that they avoid objects, activities, or situations. This can include people suffering from phobias, panic disorder, social anxiety disorder, obsessive compulsive disorder, PTSD and generalized anxiety disorder.

Although avoidance of anxiety-producing situations may make the person feel better, it ultimately can magnify the fear and worsen it. Therefore, the theory is that by providing a safe, therapist-led environment to expose patients to that which they fear, reduction of fear and avoidance will be the outcome.

Virtual Reality Exposure (VRE) is an exciting evolution of Exposure Therapy. It has emerged as a new way to deliver Exposure Therapy. VRE uses interactive simulations to help patients face previously avoided stimuli, situations, thoughts, and memories that are too complex or dangerous for therapists to recreate repeatedly in real life.

Interpersonal Therapy

IPT (Interpersonal Therapy) focuses treatment around interpersonal events in the patient’s current life. It is for this reason that IPT is often referred to as having a “here-and-now” focus as opposed to treatment for anxiety issues stemming from a childhood or developmental issues.

Typically a 12-to-16-week process, IPT therapists actively help the patient with short-term ways to improve communications and maintain firmer boundaries with specific people in their lives. Longer term goals include helping anxiety sufferers triggered by personal interaction avoid the onset of symptoms entirely without the aid of a therapist.

Overall, research has shown that psychotherapy is a moderately effective treatment for anxiety disorders. It can take time, effort and money to see results, and it is essential to find a qualified therapist who specializes in treating anxiety disorders. For Canadians without a benefits package at work that has a generous psychotherapy coverage (and many won’t), this means paying out of pocket if the funds are available.

Medications for Anxiety

Medications can also be used to treat anxiety disorders. There are several types of medications available, including benzodiazepines, selective serotonin reuptake inhibitors (SSRIs), and beta blockers.

Benzodiazepines are a type of sedative that can help reduce anxiety symptoms quickly. Producing a calming and sedative effect, this class of medication is prescribed under the names Valium®, Xanax® and Ativan®. However, they can be habit-forming and can cause dangerous side effects such as dizziness, confusion, memory problems and more. Take these powerful medications only under supervision from your medical practitioner and communicate immediately with your doctor if you notice any side effects.

SSRI’s are a type of antidepressant that has been found to be the best tolerated in treating anxiety disorders. Serotonin is an important chemical in your body, influencing learning, memory, happiness as well as regulating body temperature, sleep, sexual behaviour, and hunger.

Scientists believe that a lack of serotonin plays a role in depression, anxiety, mania and other health conditions. SSRI’s work by increasing levels of the neurotransmitter serotonin in the brain, which can improve mood and reduce anxiety.

Six SSRI’s are approved by Health Canada, including Celexa®, Cipralex®, Prozac®, Luvox®, Paxil® and Zoloft®. It can take several weeks for SSRIs to take effect, and they can cause side effects such as nausea, headache, blurred vision, dizziness, dry mouth, and sexual dysfunction. Additionally, possible withdrawal symptoms and long-term after effects when stopping SSRI’s are now well documented, so it’s very important to understand the risks before starting to take any SSRI. If you decide to stop the medication, work with your physician to develop a tapering protocol in order to mitigate withdrawal symptoms.

It’s important to note that 90% to 95% of the serotonin found in your body is found in your gut (intestines) where it is released into your blood circulation. Serotonin is made from the essential amino acid tryptophan. It cannot be made by your body and therefore must be obtained from the foods you eat.

Scientists still have a lot to learn about the role of serotonin in the body, however, it is becoming evident that diet plays an important part in regulating it.

Beta blockers were developed for the treatment of heart-related conditions, not anxiety reduction so their use for anxiety is considered “off-label use.” That means that while beta-blockers aren’t specifically intended to be used for anxiety, they can still be legally and safely prescribed for that use. 

Beta blockers are prescribed under the brand names Tenormin®, Carvedilol®, Lopresor®, and Inderal®. They reduce the physical symptoms of anxiety by blocking the effects of adrenaline in the body, which can help reduce the fight-or-flight symptoms produced by anxiety.

However, they are not effective in treating all types of anxiety disorders, do not address the root cause of anxiety, and can cause side effects such as dizziness and fatigue. Talk to your doctor to see if this medication would be right for you.

New and Emerging Anxiety Treatments

New and emerging treatments for anxiety disorders such as neurofeedback, CBD and the reemergence of psychedelics are worth paying attention to.

Neurofeedback is a non-invasive medication-free approach for treating brain-based conditions. The goal of the treatment is not only to change how patients think and feel, but also to change their brain on a biological level to speed up the process of neuroplasticity.

During treatment, the therapist uses EEG technology to measure brainwaves and introduce techniques to move the brain into the desired wave activity.  Over time, patients develop brain self-control by learning how their brains react to certain triggers. In this way they avoid undesired states, such as agitation and can recreate the desired state, such as relaxation, in their daily lives.

CBD. With medical cannabis available in Canada since 2001, medical cannabis patients have been seeking out CBD to help with anxiety for many years. And now, with recreational cannabis legalized in Canada since 2018, many high-quality, Health Canada approved CBD products exist on the market for consumers to safely purchase. While many Canadians do report anxiety reduction when taking CBD, there is still insufficient scientific evidence to support the claim that CBD is an effective treatment for depression or anxiety.

More research is underway, which will help medical practitioners in their understanding of the medicine and how to prescribe it. With the wide availability of cannabis, many Canadians continue to turn to self-medicating with CBD for anxiety relief however, ingesting too much CBD can cause side effects such as dry mouth, nausea, diarrhea, drowsiness, and disorientation. While rare, liver damage can also occur.

CBD can also have serious interactions with some medications. People who take certain blood thinners, heart rhythm medications, thyroid and seizure medications need to be particularly careful and should inform their doctors if they are taking CBD.

It’s important to work alongside your health care provider when adding CBD to your wellness regimen. While it is tempting to zip on down to the local cannabis store to self-medicate, this is a powerful plant medicine that must be safely and thoughtfully added to your health routine.

Widely used in psychiatry prior to 1967, psychedelics are making a comeback as a potentially exciting new clinical treatment for anxiety and depression. Psychedelic drugs such as ayahuasca, DMT, 5-MeO-DMT, LSD, MDMA (3,4-Methylenedioxymethamphetamine), and psilocybin have shown great promise in psychedelic-assisted psychotherapy for treating anxiety disorders.

Complementary and Alternative Treatments

Complementary and alternative treatments are also available for anxiety disorders. Examples include acupuncture, yoga, herbal supplements, massage, and aromatherapy. While some people find these treatments helpful, there is limited clinical research to support their effectiveness in specifically treating anxiety disorders.

Additionally, some of these treatments may have potential risks or interact with other medications, so it is important to discuss any complementary or alternative treatments with a healthcare professional before trying them.

Self-Help Strategies

Self-help strategies can also be effective in managing anxiety. Exercise, meditation, relaxation techniques, yoga and journaling are all examples that can help to reduce anxiety. These strategies may need to be used in conjunction with other treatments, such as medication and psychotherapy, to help manage anxiety.

Lifestyle choices and nutrition can play a significant role in the management of anxiety. By making simple modifications in your life such as prioritizing sleep and eating an anxiety-friendly diet, you can not only take control of your own health, you can also give any therapy or medication prescribed by your doctor the best chance of success.

At The Health Insider we’ll be exploring self-help for anxiety sufferers in the weeks to come, so stay tuned for more on this important topic.

The information provided on TheHealthInsider.ca is for educational purposes only and does not substitute for professional medical advice. TheHealthInsider.ca advises consulting a medical professional or healthcare provider when seeking medical advice, diagnoses, or treatment.